Provider Demographics
NPI:1235190976
Name:SLAUGHTER, MARTHA MCDANIEL (RD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MCDANIEL
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 FANCY FARM RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3363
Mailing Address - Country:US
Mailing Address - Phone:540-586-4111
Mailing Address - Fax:540-586-7071
Practice Address - Street 1:2609 FANCY FARM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3363
Practice Address - Country:US
Practice Address - Phone:540-586-4111
Practice Address - Fax:540-586-7071
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
534103OtherCOMMISSION ON DIETETIC REGISTRATION, AMERICAN DIETETIC ASSOCIATION
TXDT05674OtherLICENSED DIETITIAN